Specialista in Ortopedia Pediatrica
Sinding-Larsen-Johansson syndrome
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Quadriceps stretch (essential)
Reduce tension on the inferior pole of the patella, where the patellar tendon originates
Standing, grasp ankle and bring heel toward buttock. Keep knees together and torso upright. Feel stretch on front of thigh. If balance is difficult, hold support. Stretch should be gentle and never painful at knee. The goal is to reduce quadriceps traction on the patella.
3 × 30 seconds each side, 2-3 times daily
2.Hip flexor stretch (iliopsoas)
Reduces tension contributing to anterior knee overload
Lunge with back knee on cushion. Squeeze glute of back leg and GENTLY push hips forward. Stretch felt in front of back leg's hip. DON'T arch back. Keep torso vertical.
3 × 30 seconds each side, twice daily
3.Isometric wall sit (low range)
Strengthening without joint movement - less stress on patella
Back to wall, slide down to 30-45° (NOT too deep). Higher position = less stress on patella. Hold without moving. If painful, go higher. Exercise must be PAIN-FREE. This is safer alternative to squat in acute phase.
3-5 × 20-30 seconds, progressing when easy
4.Glute bridge
Strengthens glutes and hamstrings without stressing patella
Supine, knees bent, feet on floor. Lift pelvis contracting glutes until forming line from shoulders to knees. Don't hyperextend back. Hold 2-3 seconds at top, lower with control. This strengthens posterior chain without overloading extensor mechanism.
3 × 15 repetitions
5.Gradual step-up
Progressive functional strengthening when pain decreases
ONLY when acute pain has subsided. Step up onto low step (10-15 cm) with control. Focus on technique: knee aligned over foot, not inward. Start with very low step and gradually increase height. If pain returns, lower the step.
3 × 10 per leg, starting with low step
6.Sports load management
Activity modification is fundamental - follows same principle as Osgood-Schlatter
ACUTE PHASE: Drastically reduce jumping, running and high-impact sports. Maintain low-impact activities (swimming, cycling). GRADUAL RETURN: 50% normal load for 1-2 weeks → 75% → 100%. Principle is identical to Osgood-Schlatter: protect growth cartilage during inflammatory phase.
Personalized plan discussed during visit
7.Isometric quadriceps hold (analgesic effect)
Reduces lower patellar pole pain without tendon movement
Seated, knee bent to about 60°, foot locked under furniture or against a band. Push into extension without moving the leg, at 70% of maximum effort. Hold 30-45 seconds, breathing. Repeat 5 times with 1-2 minutes rest. This is the first-choice exercise in acute phases and before sport, because it reduces pain for several hours.
5 × 30-45 seconds, 1-2 times a day
8.Slow squat with progressive load (heavy slow resistance)
Slow progressive loading is one of the options used for patellar tendinopathy
Double-leg squat within the pain-free range. Lower in 3 seconds, rise in 3 seconds, no bouncing. Progression: weeks 1-2 bodyweight 3 × 15; weeks 3-4 with a loaded backpack 3 × 12; then 3 × 8-10 with heavier load. Do it 3 times a week on alternate days, because the tendon needs 48 hours to adapt. Pain up to 5/10 during the exercise is allowed.
3 × 8-15, 3 times a week on alternate days
9.Single-leg decline squat (eccentric)
Concentrates load on the patellar tendon once pain is controlled
Only when daily pain is ≤ 3/10. Standing on a board inclined about 25° (or on a step with heels higher than toes), SLOWLY lower on one leg to 60° over 4 seconds, then rise using both legs. Keep the knee aligned over the foot. If pain exceeds 5/10 or does not settle within 24 hours, reduce depth or reps.
3 × 10 per leg, on alternate days
10.Gluteus medius and core strengthening
A stable hip reduces repeated overload on the lower patellar pole
CLAMSHELL: side-lying, knees at 90°, open the top knee keeping the pelvis still, 3 × 15. SIDE PLANK: on forearm and knees (or feet if easy), body aligned, 3 × 20-30 seconds each side. These exercises do not load the patellar tendon and can be done daily even in the painful phase.
Clamshell 3 × 15 each side; side plank 3 × 20-30 seconds
11.Gradual return to jumping and running
The tendon must be re-accustomed to explosive load before returning to the team
Criteria to start: daily pain ≤ 2/10, slow squat 3 × 15 pain-free, 10 single-leg hops tolerated. PHASE 1 (1-2 weeks): easy running and two-legged hops in place. PHASE 2: single-leg hops and short bounds, controlling the landing with a soft, aligned knee. PHASE 3: sport-specific training and finally matches. Keep slow squats twice a week even after returning, to prevent relapses.
Weekly progression guided by symptoms
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Athletic adolescents with pain at the lower pole of the patella. Similar to Osgood-Schlatter but different location.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Quadriceps stretch (essential)
Reduce tension on the inferior pole of the patella, where the patellar tendon originates
Standing, grasp ankle and bring heel toward buttock. Keep knees together and torso upright. Feel stretch on front of thigh. If balance is difficult, hold support. Stretch should be gentle and never painful at knee. The goal is to reduce quadriceps traction on the patella.
3 × 30 seconds each side, 2-3 times daily - 2
Hip flexor stretch (iliopsoas)
Reduces tension contributing to anterior knee overload
Lunge with back knee on cushion. Squeeze glute of back leg and GENTLY push hips forward. Stretch felt in front of back leg's hip. DON'T arch back. Keep torso vertical.
3 × 30 seconds each side, twice daily - 3
Isometric wall sit (low range)
Strengthening without joint movement - less stress on patella
Back to wall, slide down to 30-45° (NOT too deep). Higher position = less stress on patella. Hold without moving. If painful, go higher. Exercise must be PAIN-FREE. This is safer alternative to squat in acute phase.
3-5 × 20-30 seconds, progressing when easy - 4
Glute bridge
Strengthens glutes and hamstrings without stressing patella
Supine, knees bent, feet on floor. Lift pelvis contracting glutes until forming line from shoulders to knees. Don't hyperextend back. Hold 2-3 seconds at top, lower with control. This strengthens posterior chain without overloading extensor mechanism.
3 × 15 repetitions - 5
Gradual step-up
Progressive functional strengthening when pain decreases
ONLY when acute pain has subsided. Step up onto low step (10-15 cm) with control. Focus on technique: knee aligned over foot, not inward. Start with very low step and gradually increase height. If pain returns, lower the step.
3 × 10 per leg, starting with low step - 6
Sports load management
Activity modification is fundamental - follows same principle as Osgood-Schlatter
ACUTE PHASE: Drastically reduce jumping, running and high-impact sports. Maintain low-impact activities (swimming, cycling). GRADUAL RETURN: 50% normal load for 1-2 weeks → 75% → 100%. Principle is identical to Osgood-Schlatter: protect growth cartilage during inflammatory phase.
Personalized plan discussed during visit - 7
Isometric quadriceps hold (analgesic effect)
Reduces lower patellar pole pain without tendon movement
Seated, knee bent to about 60°, foot locked under furniture or against a band. Push into extension without moving the leg, at 70% of maximum effort. Hold 30-45 seconds, breathing. Repeat 5 times with 1-2 minutes rest. This is the first-choice exercise in acute phases and before sport, because it reduces pain for several hours.
5 × 30-45 seconds, 1-2 times a day - 8
Slow squat with progressive load (heavy slow resistance)
Slow progressive loading is one of the options used for patellar tendinopathy
Double-leg squat within the pain-free range. Lower in 3 seconds, rise in 3 seconds, no bouncing. Progression: weeks 1-2 bodyweight 3 × 15; weeks 3-4 with a loaded backpack 3 × 12; then 3 × 8-10 with heavier load. Do it 3 times a week on alternate days, because the tendon needs 48 hours to adapt. Pain up to 5/10 during the exercise is allowed.
3 × 8-15, 3 times a week on alternate days - 9
Single-leg decline squat (eccentric)
Concentrates load on the patellar tendon once pain is controlled
Only when daily pain is ≤ 3/10. Standing on a board inclined about 25° (or on a step with heels higher than toes), SLOWLY lower on one leg to 60° over 4 seconds, then rise using both legs. Keep the knee aligned over the foot. If pain exceeds 5/10 or does not settle within 24 hours, reduce depth or reps.
3 × 10 per leg, on alternate days - 10
Gluteus medius and core strengthening
A stable hip reduces repeated overload on the lower patellar pole
CLAMSHELL: side-lying, knees at 90°, open the top knee keeping the pelvis still, 3 × 15. SIDE PLANK: on forearm and knees (or feet if easy), body aligned, 3 × 20-30 seconds each side. These exercises do not load the patellar tendon and can be done daily even in the painful phase.
Clamshell 3 × 15 each side; side plank 3 × 20-30 seconds - 11
Gradual return to jumping and running
The tendon must be re-accustomed to explosive load before returning to the team
Criteria to start: daily pain ≤ 2/10, slow squat 3 × 15 pain-free, 10 single-leg hops tolerated. PHASE 1 (1-2 weeks): easy running and two-legged hops in place. PHASE 2: single-leg hops and short bounds, controlling the landing with a soft, aligned knee. PHASE 3: sport-specific training and finally matches. Keep slow squats twice a week even after returning, to prevent relapses.
Weekly progression guided by symptoms
Frequently Asked Questions
What is the difference between Sinding-Larsen-Johansson and Osgood-Schlatter?
Both are traction osteochondroses of the knee extensor mechanism. Osgood-Schlatter affects the tibial tuberosity (below the knee), Sinding-Larsen-Johansson the inferior pole of the patella (above the patellar tendon). Treatment is similar: stretching, sports load management and progressive strengthening.
At what age does Sinding-Larsen-Johansson syndrome appear?
It typically appears between ages 10 and 14, slightly earlier than Osgood-Schlatter, during rapid growth spurts. It's more common in athletic children, especially those in sports involving jumping and running (soccer, basketball, volleyball).